Revisions

21-2, Adds Appendix XIII

Revision Notice 21-2; Effective July 28, 2021

 

The following change(s) were made:

Section Title Change
Appendix XIII State Cutoff Dates Describes the state cutoff process and includes a state cutoff chart.

21-1, Adds Section 4822

Revision Notice 21-1; Effective April 1, 2021

 

The following change(s) were made:

Revised Title Change
4822 Time Frames for Minor Home Modifications Adds a new section to minor home modification policy to clarify the time frame for completion of minor home modifications.

20-3, Changes to Sections 2030, 6000, 6200, 6300 and Appendix III; Adds Form 2605

Revision Notice 20-3; Effective December 1, 2020

 

The following change(s) were made:

Revised Title Change
2030 Managed Care Organization Coordination Updates requirements of Senate Bill 1207, Member SK-SAI MDCP review signature form. Adds headings and forms detail.
6000 Denials and Disenrollment Updates description of section to include the disenrollment policy, updates Texas Administrative Code (TAC) references and the adverse benefit notification to 10 business days. Removes the Program Support Unit (PSU) tables and procedures. Deletes Sections 6110, 6120, 6130 and 6140.
6200 Denial/Termination of Medically Dependent Children Program Clarifies denial reasons to program level denials and updates managed care organization (MCO) and PSU coordination procedures. Removes reasons not applicable per the code.
6300 Disenrollment from Managed Care Changes the section title, removes MCO denials and adds disenrollment information and a reference to the Uniform Managed Care Manual. Deletes Sections 6320, 6330, 6340, 6350, 6360 and 6370.
Appendix III LTSS Billing Matrix and Crosswalk Adds UC modifier for the CDS Option to Medically Dependent Children Program waiver services for minor home modifications and adaptive aids to Codes T2028, T2029, T2039 and S5165.
Form 2605, Form 2605-S and Instructions Member SK-SAI MDCP Review Signature Adds a new form and instructions per requirement of Senate Bill 1207.

20-2, Changes to Section 1614, Section 3200, Section 3327.1, Section 3410, Section 4300, Section 4400 and Section 5212

Revision Notice 20-2; Effective September 1, 2020

 

The following change(s) were made:

Revised Title Change
1614 When and What Information May Be Disclosed Adds a link to an online question and complaint form.
3200 Member Reassessment Adds a requirement to submit the Individual Service Plan (ISP) tracking tool to the LTC Portal upon reassessment.
3327.1 Process for Reviewing the Individual Service Plan Expiring Report Removes Program Support Unit (PSU) processes and updates managed care organization (MCO) requirements for how to retrieve and use the report.
3410 Transfer from One Managed Care Organization to Another Updates how members may request an MCO transfer. Adds headings throughout the section for clarity. Updates the requirements for both the gaining and losing MCO. Updates the time frames to provide information.
4300 Private Duty Nursing Updates the section to match MCO notice guidance. The MCO must follow the Texas Medicaid Provider Procedure Manual (TMPPM) guidance for private duty nursing. Removes all other language as the information is in the TMPPM. Moves Section 4330 to 4310 and deletes Sections 4311 and 4320.
4400 Prescribed Pediatric Extended Care Centers Updates references, citations and information to match TMPPM guidance. Changes the flow of information for reading and ease of use, adding Section 4411 and moving information previously in 4411 to 4412.
5212 Services Available in the CDS Option Changes the title of the section and adds information based on House Bill 4533 services available in the Medically Dependent Children Program (MDCP) Waiver under the Consumer Directed Services (CDS) Option.